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1700634271 [5] 袁伟杰，吴灏，于光．连续性高容量血液滤过对重症急性肾功能衰竭患者外周血细胞因子的影响．中华急诊医学杂志，2003，12(2):86-88.

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1700634273 [6] Raymond V, Wim VB, Norbert L. What is the renal replacement method of first choice for intensive care patients. J Am Soc Nephrol, 2001, 12, S40-43.

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1700634275 [7] Emre F, Tim S, Sharam Z, et al. Impact of different modalities of continous venoneous hemofiltration on sepsis-induced alterations in experimental pancreatitis, Kidney Inter, 2002, 62:1806-1818.

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1700634277 [8] Cole L, Bellomo R, Journois D, et al. High-volume haemofiltration in human septic shock. Intensive Care Med. 2001, 27(6):978-86.

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1700634279 [9] Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis, Artif Organs, 2003, 27(9):792-801.

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1700634281 [10] Patel GP, Gurka DP, Balk RA. New treatment strategies for severe sepsis and septic shock. Curr Opin Crit Care. 2003; 9(5):390-6.

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1700634283 [11] A yala A, Chung CS, Grutkoski PS, et al. Mechanisms of immune resolution. Crit Care Med. 2003, 31（8 Suppl):S558-71.

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1700634285 （陈江华　张萍）

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1700634290 内科学新进展 [:1700627022]

1700634291 内科学新进展 第八章　心肺复苏新进展

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1700634293 摘　要　基本生命支持包括判断技能和支持技术。判断技能需要快速准确的识别患者有无生命体征；支持技术包括开放气道、呼吸支持、胸外按压和电除颤，简称A、B、C、D四项步骤。有效的循环支持依靠有效的胸外按压、合适的胸外按压／通气比例和电除颤。2005年指南推荐成人的按压／通气比例无论单人或双人均为30:2，这与2000年指南有着明确的不同。电除颤分为单向波除颤和双向波除颤，如为单向波除颤能量应用360J, 而双向波除颤能量≤200J与单向波除颤同样安全有效的。BLS成功的标志是自主循环恢复。随后实施的进一步生命支持包括建立静脉通路，应用各种血管活性药物、抗心律失常药物，进行脏器功能监测。复苏后治疗能够改善早期由于血液动力学不稳定和多脏器功能衰竭引起的死亡率。

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1700634295 Abstract　Basic life support（BLS）includes the technology of recognition and support. Recognition of signs of cardiac arrest should be quick and accurate, then support maneuvers including opening the airway, delivering rescue breathing, chest compressions and defibrillation are exerted sequentially, four support maneuvers are abbreviated to ABCD according to their words. Effective support of circulation depends on effective chest compressions, appropriate compression ventilation ratio and defibrillation. The compression ventilation ratio has been changed from 15:2 to 30:2 according to the 2005 AHA Guidelines for CPR and ECC, in despite of one or two rescuers. It is definitely difference from the 2005 guidelines. Modern defibrillators are classified according to 2 types of waveforms: monophasic and biphasic. The consensus was that rescuers using monophasic waveform defibrillator should give an initial shock of 360 J; if ventricular fibrillation（VF）persists after the first shock, second and subsequent shocks of 360 J should be given. Defibrillation with biphasic waveforms of relatively low energy（≤200 J）is safe and has equivalent or higher efficacy for termination of VF than monophasic waveform shocks of equivalent or higher energy. Return of spontaneous circulation（ROSC）is the symbol of success of BLS. At the period of ACLS, establish or verify existing intravenous access, and verify the function of any catheters in place. Vasoactive agents and anti-arrhythmic drugs should be used to keep hemodynamics stabilization. The function of organs should be monitored. And post-resuscitation care has significant potential to improve early mortality caused by hemodynamic instability.

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1700634297 《国际心肺复苏和心血管急救指南2000》颁布后，近年又有新的科学研究证据，以及专家们对其进一步的学术评价，经过5年之久的使用后，再度获得科学上的意见共识，在此基础上重新修订了《国际心肺复苏和心血管急救指南2005》，使推荐方案更适于挽救患者生命。现代心肺复苏术的确立是临床医学的一个里程碑。

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1700634302 内科学新进展 [:1700627023]

1700634303 内科学新进展 第一节　成人基本生命支持

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1700634305 基本生命支持（base life support, BLS）是心肺复苏指南中讨论和关注的重点。BLS包含A、B、C、D步骤与方法，A、B、C、D分别指开放气道（airway)、呼吸（breathing）支持、循环（circulation）支持和电除颤（defibrillation)。

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1700634307 BLS看似简单，但经科学证实并非易事，必须严格按照要求实施。

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1700634309 一、基本生命支持的适应证

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1700634311 （一）呼吸骤停

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1700634313 很多原因可造成呼吸骤停（respiratory arrest)，包括溺水、卒中、气道异物阻塞、吸入烟雾、会厌炎、药物过量、电击伤、窒息、创伤、心肌梗死、电击伤以及各种原因引起的昏迷。原发性呼吸停止后，心脏仍可在数分钟内得到已氧合的血液供应，大脑及其他脏器也同样可得到数分钟的血供，此时，尚未出现循环停止的征象。当呼吸骤停或自主呼吸不足时，保证气道通，进行急救人工通气非常重要，可防止心脏发生停搏。

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1700634315 （二）心搏骤停

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1700634317 心搏骤停（cardiac arrest）时血液循环停止，各重要脏器失去氧供。心跳骤停早期，可出现无效的“叹息样动作”，但不应与有效的呼吸动作相混淆。

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1700634319 四种心律可引起无脉性心搏骤停：心室颤动（ventricular fibrillation, VF)、快速性室性心动过速（rapid ventricular tachycardia, VT)、无脉性电活动（pulseless electrical activity, PEA）和心脏停搏（asystole)。

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